TJPRC: International Journal of Nephrology, Renal

Therapy and Renovascular Disease (TJPRC: IJNRTRD)

Vol. 2, Issue 1, Jun 2018, 7-12
© TJPRC Pvt. Ltd.

CROSS SECTIONAL STUDY OF ACUTE KIDNEY INJURY DURING

PREGNANCY IN TERTIARY CARE GOVERNMENT

HOSPITAL -AN INDIAN PERSPECTIVE

SREEDHARA. C. G, UMESH. L, SHIVAPRASAD & MAHESH. V

Department of Nephrology, Institute of Nephrourology, Victoria Hospital Campus, Republic of India,
Bengaluru, Karnadaka, India
ABSTRACT

AKI occurs in about 13.30 million people per year, nearly 85% of whom live in the developing world, and no
direct link between AKI and death has yet been shown, AKI is thought to contribute to about 1.7 million deaths every
year. AKI is potentially preventable and treatable with timely intervention, but there continues to be a high human
burden. Which specific factors account for the poor outcomes and to what extent variations in care delivery contribute is
unclear. The ability to provide lifesaving treatments for AKI provides a compelling argument to consider therapy for the
affected population. However, there is a paucity of data on pregnancy-related AKI in Indian women. The present study to

Original Article
know the incidence of AKI in tertiary care hospitals and also correlates the associated risk factors on a retrospective
basis. This was a retrospective study conducted at Government tertiary care hospitals of Bangalore, Karnataka. The
retrospectively we have obtained the data sets from patient records, inclusion and exclusion criteria rule was applied for
the collection of entire data sets. Total 400 patients were included in the study intervention, aged between 21-39 years,
mean age of the patients was 27.52±2.31 years (ODD 2.36);mean gestational age was 31.22 with SD 0.98 weeks (odd
4.77), primipara were seen in 225 (odd 13.36), parity 2 and 3 were distributed 135 and 40 cases respectively. The
incidence of dialysis was 2.60%. HELLP syndrome and pre-eclampsia (71.57%;odd 22.52, p=0.001), Postpartum
hemorrhage (2.99%, odd odd 0.25, p=0.112), Ectopic pregnancy (1.99%, odd 1.89, p=0.036), Amniotic fluid embolism
(1.24%, odd 0.25 p=0.2213), Pregnancy fatty lives (0.49%, odd 0.10 p=0.3662), Peripartum cardiomyopathy (2.49%, odd
11, p=0.8524), Gestational diabetes mellitus (5.48%, odd 10.55 p=0.036), Postpartum retention of urine (1.49% odd 1.36
p=0.158). Mechanical ventilation was done to support 25.5% and inotropic support was needed by 45.67% patients. The
present study concludes that AKI was the most frequent complications of pregnancy period, which are complications that
can be easily identified and treated during the early pregnancy or onset of pregnancy time.

KEYWORDS: AKI; Acute Kidney Injury, Pregnancy, HELLP Syndrome & Pre-eclampsia

Received: Feb 15, 2018; Accepted: Mar 08, 2018; Published: May 17, 2018; Paper Id.: TJPRC: IJNRTRDJUN20182

INTRODUCTION

According to past literature and Report of Indian Ministry of Health and Family welfare (MOHF),
Government of India, the maternal mortality rate was 27.09 per 100,0000 live births in 2011. The acute Kidney
Injury is very common during the pregnancy and puerperium. Although, it is related to increased morbidity and
mortality rate. The incidence of AKI was found to be declined in mid-income and developing countries (1, 2). It is a
major contributor to poor patient outcomes. AKI occurs in about 13.30 million people per year, nearly 85% of
whom live in the developing world, and no direct link between AKI and death has yet been shown, AKI is thought

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8 Sreedhara. C. G, Umesh. L, Shivaprasad & Mahesh. V

to contribute to about 1.7 million deaths every year (3). The course of AKI varies with different geographical setup and the
severity or duration of illness affects outcomes such as dialysis requirements, renal function recovery, and survival.
Recognition is increasing the effect of AKI on patients, the resulting societal burden of its long-term effects, including the
development of chronic kidney disease and end-stage renal disease needing dialysis or transplantation. In Indian
perspective, many literatures revealed that AKI has become a rare complication of pregnancy. Since the 1980s, its
incidence in Industrialized countries has decreased dramatically because of the disappearance of septic abortion and
improved prenatal care. AKI is potentially preventable and treatable with timely intervention, but there continues to be a
high human burden. Which specific factors account for the poor outcomes and to what extent variations in care delivery
contribute are unclear. The ability to provide lifesaving treatments for AKI provides a compelling argument to consider
therapy for the affected population. However, there is a paucity of data on pregnancy-related AKI in Indian women. The
present study to know the incidence of AKI in tertiary care hospitals and also correlates the associated risk factors on the
retrospective basis.

METHODS

This was a retrospective study conducted at Government tertiary care hospitals of Bangalore, Karnataka. The
retrospectively we have obtained the data sets from patient records, inclusion and exclusion criteria rule was applied foe
the collection of entire data sets.. The inpatient database contained information on patient’s name, age, gender, and
diagnosis. Patients who discharged from January 2015 to June 2016 were screened in accordance with the following
diagnoses: 1. Pregnancy or puerperium; 2. Acute renal failure, acute renal insufficiency, or acute kidney injury; (In
regional language, we use the same character to indicate renal and kidney). A review of complete medical records
confirmed the diagnosis of AKI. A total 400 sampled data were extracted from the database source, a male comprises 250
and female comprised 150 patients respectively. Pregnancy complications, co-morbidities and risk factors were extracted
from pre-tested questionaries. Univariate; ‘ANOVA’ and logistic regression statistical methods were employed to test the
hypothetical results.

RESULTS

Table1: Basic Information of Patients

(N=400)
Parameter Mean±SD Odd Ratio P-Value
Age (years) 27.52±2.31 2.36 0.0012**
Gestational weeks upon admission(weeks) 31.22±0.98 4.77 0.0036**
Primipara (%) 225 13.36 0.0018**
G2 135 10.87 0.0002**
G3 40 6.3 0.0036**
Blood urea nitrogen (umol/L) 9.12±6.33 2.28 0.0011**
Serum creatitine > 221 mmol/L 59(%) 3.96 0.0362**
** Significant at 1% level (p<0.01)

Total 400 patients were included in the study intervention, aged between 21-39 years, mean age of the patients
was 27.52±2.31 years (ODD 2.36); mean gestational age was 31.22 with SD 0.98 weeks (odd 4.77), primipara were seen in
225 (odd 13.36), parity 2 and 3 were distributed 135 and 40 cases respectively with odd ration 10.87 and 6.3.
Hematological parameters were done at greater accuracy mean BUN was 9.12 and serum creatine >221 seen in 59 cases.
The parameters were statistically significant at an incidence of AKI (p<0.01). AKI is independent risk factors of mortality

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Cross Sectional Study of Acute Kidney Injury During Pregnancy in Tertiary 9
Care Government Hospital -An Indian Perspective

and morbidity of the infected cases. General mortality was 6.50% and mortality due to AKI was 19.85% (p=0.0025). In the
multivariate analysis, risk factors for AKI were caesarean delivery (95% CI = 0.55-0.89, p=0.0001) AND
THROMBOCYTOPENIA (95% CI=2.86-6.33, p=0.0085). AKI was intuitive risk factors for secondary complications as it
would be increased mortality and morbidity.

Table 2: Distribution of Pregnant Complications

Parameter No (%) Odd Ratio P-Value
Pre-eclampisa 287 (71.57%) 22.52 0.0001**
Eclampisa 55(13.71%) 15.63 0.0028*
HELLP syndrome 3(0.74%) 0.25 0.1125ns
Postpartum hemorrhage 12(2.99%) 1.89 0.0362 ns
Ectopic pregnancy 8(1.99%) 0.96 0.168 ns
Amniotic fluid embolism 5(1.24%) 0.25 0.2213 ns
Pregnancy fatty live 2(0.49%) 0.10 0.3622 ns
Peripartum cardiomyopathy 01(2.49%) 0.11 0.8524 ns
Gestational diabetes mellitus 22(5.48%) 10.55 0.03655 ns
Postpartum retention of urine 6(1.49%) 0.79 0.8772 ns
Co Morbidities
Chronic kidney disease 32(7.98%) 5.5 0.002*
Primary heart diseases 08(1.99%) 2.14 0.185 ns
Obstructive nephropathy 03(0.74%) 1.87 0.263 ns
Pyelonephritis 07(1.74%) 2.26 0.174 ns
** Significant at 1% level (p<0.01), ns-non significant

The incidence of dialysis was 2.60%. HELLP syndrome and pre-eclampsia (71.57%;odd 22.52, p=0.001),
Postpartum hemorrhage (2.99%, odd odd 0.25, p=0.112), Ectopic pregnancy (1.99%, odd 1.89, p=0.036), Amniotic fluid
embolism (1.24%, odd 0.25 p=0.2213), Pregnancy fatty lives (0.49%, odd 0.10 p=0.3662), Peripartum cardiomyopathy
(2.49%, odd 11, p=0.8524), Gestational diabetes mellitus (5.48%, odd 10.55 p=0.036), Postpartum retention of urine
(1.49% odd 1.36 p=0.158). Mechanical ventilation was done to support 25.5% and inotropic support was needed by
45.67% patients. According to the RIFLE criteria, the majority of the patients fall under risk category followed by injury.
15% of the patients developed end stage renal disease. Co morbidity status was enlisted Chronic kidney disease was seen
in 32 cases (7.98%), Primary heart diseases 08 (1.99%), Obstructive nephropathy 03 (0.74%) and Pyelonephritis 07
(1.74%) respectively table (2).

DISCUSSIONS

AKI is one of the main conditions associated with high mortality (20%) in poor prognosis in poor resource set up.
The pregnancy causes of AKI are common in the Indian context (developing countries), but are still an important public
health problem in the developing world which reflects the precarious prenatal care. Much literature opined that AKI in the
criticallyillpatients has a high prevalence varying from 15-25%, and dialysis is required in around 56% of cases. In
pregnancy, AKI is still not well studied, and its determinant factors should be better investigated. It is estimated that AKI
occurs in 1 out of 20,000 pregnancies in developed countries. In the present study, the main causes of the event were
pregnancy-associated complications, which is in accordance with previous studies showing that these are the main
complications of pregnancy. AKI occurs 1-2% of cases, but only severe AKI was considered. Among the comorbidities
found in the present study. Pregnancy complications is represents the main causes of the maternal mortality in the Indian
scenario.

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10 Sreedhara. C. G, Umesh. L, Shivaprasad & Mahesh. V

CONCLUSIONS

In summary, the study concludes that AKI was the most frequent complications of pregnancy period, which are
complications that can be easily identified and treated during the early pregnancy or onset of pregnancy time. Population -
based study would be required for decision making and prevention of AKI in developing countries like India.

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